Abstract
BackgroundTotal hip and knee arthroplasty are a highly performed surgery; however, patient satisfaction with surgery results and patient involvement in the decision-making process remains low. Patient decision aids (PtDAs) are tools used in clinical practices to facilitate active patient involvement in healthcare decision-making. Nonetheless, PtDA effects have not been systematically evaluated for hip and knee total joint arthroplasty (TJA) decision-making. The aim of this systematic review is to determine the effect of patient decision aids compared to alternative of care on quality and process of decision-making when provided to adults with hip and knee osteoarthritis considering primary elective TJA.MethodsThis systematic review will follow the Cochrane Handbook for Systematic Reviews. This protocol was reported based on the PRISMA-P checklist guidelines. Studies will be searched in CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science. Eligible studies will be randomized control trial (RCT) evaluating the effect of PtDA on TJA decision-making. Descriptive and meta-analysis of outcomes will include decision quality (knowledge and values-based choice), decisional conflict, patient involvement, decision-making process satisfaction, actual decision made, health outcomes, and harm(s). Risk of bias will be evaluated with Cochrane’s risk of bias tool for RCTs. Quality and strength of recommendations will be appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE).DiscussionThis review will provide a summary of RCT findings on PtDA effect on decision-making quality and process of adults with knee and hip osteoarthritis considering primary elective TJA. Further, it will provide evidence comparing different types of PtDA used for TJA decision-making. This review is expected to inform further research on joint replacement decision-making quality and processes and on ways PtDAs facilitate shared decision-making for orthopedic surgery.Systematic review registrationPROSPERO CRD42020171334
Highlights
Osteoarthritis (OA) is a leading cause of disability worldwide impacting health on an individual and population level [1, 2]
With the proportion of seniors living in industrialized countries growing rapidly [54, 55], it is fundamental to improve current total joint arthroplasty (TJA) decision-making processes that can lead to improved healthcare efficiency, better patient expectations, better patient and surgeon experiences, and reduced burden on the healthcare system
According to International Patient Decision Aids Standards (IPDAS) [58], minimum criteria to be defined as a Patient decision aids (PtDAs) are (1) to make explicit that a decision has to be made, (2) helping patients to choose amongst options, (3) presentation of associated positive and negative outcome for each option, (4) outcomes presented are relevant to health status, (5) the tool should not favor any option, and (6) the tool needs to assist in personal values clarification
Summary
Osteoarthritis (OA) is a leading cause of disability worldwide impacting health on an individual and population level [1, 2]. TJA is an elective surgery and the third most performed inpatient surgery in Canada, with 58,492 total hip arthroplasty (THA) and 70,502 total knee arthroplasty (TKA) performed in 2018 [9] This represents a volume increase of 17.0% compared to 2013 [9]. Similar trends are seen worldwide and numbers are expected to continue rising [10,11,12,13] This phenomenon is concerning for healthcare systems considering the inpatient and outpatient resources needed for TJA procedure [9, 14, 15]. PtDA effects have not been systematically evaluated for hip and knee total joint arthroplasty (TJA) decision-making.
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